Risk-reducing mastectomy in healthy women with BRCA mutation: a narrative review

Introduction: Breast cancer (BC) prevention in BRCA1/2 mutation carriers remains a significant clinical challenge. Risk-reducing mastectomy (RRM) is the most effective preventive option, lowering BC incidence by over 90%. Despite its survival benefit, the decision to undergo RRM is complex and shaped by psychological, social, and healthcare access factors. Areas covered: This narrative review synthesizes evidence on the oncologic efficacy, safety, and outcomes of RRM in BRCA mutation carriers. Literature was identified through PubMed, Scopus, and Web of Science up to March 2025. Large cohort studies and systematic reviews confirm the effectiveness of RRM. Nipple-sparing mastectomy offers comparable oncologic safety with improved cosmetic and psychological outcomes. Histopathologic analyses frequently reveal occult malignancies, supporting the role of early surgery. However, surgical complications, sensory loss, and sexual health impacts remain important considerations. Expert opinion: RRM is cost-effective, especially when performed at younger ages, but disparities in access to genetic testing and surgery persist. Special populations, such as ovarian cancer survivors and those diagnosed before genetic testing, require individualized care. Advances in risk stratification, surgical techniques, and psychosocial support will enhance outcomes. A multidisciplinary, patient-centered approach is essential for informed decision-making.